Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM )(3% WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla. New York 10595 _914) 593-5 75 _ NYS-ELAP No. 101 Time/Date Set: Form A-70 (rev. 1/96/

pie Type (circle one): 0-95ol k 36,61810910,$/ QSsce 002405 ’ QEsc4, F£OS535 PFBW54( S55, ■ 1. Potable ) .. Kill! Colbo Terlrd Bolle *Si ------------------------ ----- - ----- 2: Non Potable 4. Other___________ _ Chain of Custody? ...... yes___ no Time/Date Collected: .----- +-0+ Comments: - Collected By: __ ___ Agency Code: _ ___ PWS#: Source ID: Type Descriptor: _ Coh ! .4 : rs;!: t.-.:: 1. Location's/Individual's Name___ L Name/Company Street... . .. L___ :,2 —A Street_____ _________ City/SVZip_4 1/-201000,/07a City/St/Zip Identification of Source Phone#: Fax#; _ Collection Point.. _ 5 4. . ’..V CA,CH, Bl? _ Check#: Amounts___

z/H584205C4. —NAlo ; JNGANC ANA’Ysi 0l UcC NNPOTARLE/S01/0 ANALYSIS Lab#: Lab#:___ (circle tests) 1. Heterotrophic Plate (circle tests) /2 1. Trihalomethanes (524) : : :: alg i i. T * . (i ’ 1 dtsn Count (hemodialysis & all others) 2.1 Volatile Halocarbons (524) ‘ lAmami (-1401) 2. Coliform P/A (public supplies) (3.) Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (pnv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4, Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) 2 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081) 6. Macroscopic f.Pesticides/PCB screen (508) j. Methoprene (616) 7.APIL 8.1 PCB as Decachlorobiphenyl (508A) ..8, Herbicides (EPAI 978/8151) MKher: 9. Herbicides (515) 9. Pesticides (SM18/6630) ■. 10. Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13). Refrigerated? _ yes

Chlorinated:? ....... . yes _ no

no 11. Carbamate Pesticides (531)‘ 11. 12. Glyphosate (547) Glycols id n i 1 vt. i.'l.ibk-: (I oo/t / i e 13. Diquat (549) 13. Base Neutral Extractables (625/8270) ' Free Chlorine Res: mg/L 14. Chlorination Disinfection Byproducts (551) 14. GC/MS Semivolatile Unknown Scan Total Chlorine Res: - mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH __ 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB's (DEF) 18. Other:.____ __ _______________ __ ___ 18. Other:_____ _______________________

NOU«ANC ANALYSIS REQUESTED - ! L - (circle tests) 1. Color 11111117 2. Turbidity 3.DH 20. Acidity— e 21. Alkalinity, as CaCOs 22 Bromide 39.1Aluminum Mo. Antimony 41. Arsenic nll yZAm.b ■>:' *ellm* CL encor 50. Selenium , 51. Silver [ cl 4. Conductivity 5. Corrosivity (temp:_____ °C) 23. Bromate/Chlorate/Chlorite 24. Chloride 42.Banum0900 43. Beryllium 52. Sodium 33. Thallium 44. Boron 54 .Vanadium 6. BOD (5 day) 25 Cyanide 7. Soluble BOD (5 day) 26. Fluoride 45.admium ■ 35, Zinc | 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46.Calcium, as CaCO3 CLP men 67. Volatiles - 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47Calcium, Ca42 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromium, Total 11. Total Organic Carbon 20 N;tn.(h n rdtdos N 41.1 ; ‘i* - Mr* > iezr ,2213 ts Neni viol, dll: " 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50.Cobalt 6* Ceatde/PC!* 13. Solids, Percent (%) 32. Oil an Grease j152. 51. Copper Iron — / Dsk 0 n sabl* 14. Solids, Settleable 33. Phenol 53.-eado2 TCLP 71TCLP-Metals 15. Solids, Suspended eSolids, Total 17. Solids, Total Dissolved 34 Phosphorus Total as P

_ -56. 36.37, SulSurffaatesctants L 35. Phosphorus, Ortho as P 54,551/anqanese agnesium 72.TCLP-Pesticides 18. Solids, Total Volatile .. Ot TI 38.UV254n Mercury 158. Nicykelbdenum 57 Mol and 74.TCLP-Volatiles 73. TCLP-Herbicides

75.TCLP-BNAS ■IB NYC-WTC_000026406